Pete Ripley Director of Service Delivery Scottish Ambulance Service 10 th January 2011

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1 Pre-Hospital (EMS) Services in Scotland Pete Ripley Director of Service Delivery Scottish Ambulance Service 10 th January 2011

2 My background I joined the ambulance service in 1982 I am a qualified paramedic I have worked in a number of English Ambulance Services I have worked in virtually every role, including operational paramedic, paramedic trainer, EMDC trainer, operational manager, EMDC manager and as a Director in both East Midlands Ambulance Service and Scotland

role, including operational paramedic, paramedic trainer, EMDC trainer, operational

3 The Scottish Ambulance Service Covers the whole of Scotland (78,789 sq kms) the largest geographic area of any ambulance service in the UK Includes the Western Isles, Shetland and Orkney Serves 5.1 million people Operates from 178 locations across five operational divisions Budget of 208 million (1.9 billion Norwegian Krone)

4 Facts & Figures Employs 4,300 staff 2,500 A&E staff, 1,150 Patient Transport Staff (PTS) Responds to 450, calls a year Responds to 150, urgent calls a year 4,000 Air Ambulance missions a year 1.6 million Patient Transport journeys Has dedicated Risk & Resilience teams Has 3 Emergency Medical Dispatch Centres (EMDCs)

year 4,000 Air Ambulance missions a year 1.

5 Operational Divisions

6 Operations Front line A&E ambulances Paramedic Response Units Paramedic Practitioners Urgent Tier Cycle Response

7 Operational focus Patient centred Clinical excellence Equity of Service Delivery Integrated working

8 Paramedic Practitioners Autonomous practitioners with the ability to assess, diagnose, treat, discharge and/or refer patients with acute or chronic illness or injuries Aim to treat and discharge at scene or provide more appropriate referral patient pathway away from A&E departments, streamlining services and enhancing patient care and experience Have a key role in reducing unnecessary A&E admissions Focus on anticipatory care

provide more appropriate referral patient pathway away from A&E departments, streamlining services and

9 Emergency Medical Dispatch Centres (EMDCs) Three EMDCs at Glasgow, Edinburgh and Inverness All jointly located with NHS24 National air desk in the Glasgow EMDC Paramedic Advisors in each EMDC We have virtual call handling Developing virtual dispatch Work closely l with NHS 24 on triage and capacity management

EMDC Paramedic Advisors in each EMDC We have virtual call handling Developing

10 Air Ambulance Aircraft 2 x EC 135 helicopters 2 x King Air aircraft 4000 missions annually 24/7 availability Government tf funded d 12 million annually

11 Inverness Aberdeen Air Bases Glasgow Airport Glasgow helibase

12 Air Ambulance Roles 70% Transfers from remote & rural locations 7% Movement of specialist transfer & retrieval teams 23% Pre-hospital emergencies (HEMS)

13 EMRS Emergency Medical Retrieval Service Consultant led Critical Care Transport In partnership with the ambulance service

14 National Risk & Resilience 106 full-time SORT Specialists (Special Operations Response Team) 106 SCBA and CBRN trained 106 CBRN Clinical decontamination 40 Swift Water Rescue Technicians 40 Urban Search and Rescue 40 Offshore Response All Team leaders trained in Scene management - Gold CBRN, Gold Multi-Agency, Silver & Bronze Commanders

Water Rescue Technicians 40 Urban Search and Rescue 40 Offshore Response All Team

15 National Risk & Resilience Technical Capabilities Mass casualty evacuation & crowd-related incidents Terrorism & firearms Clinical decontamination High risk events ie Papal visit, Olympics Water Incident support All-terrain retrieval

firearms Clinical decontamination High risk events ie

16 Patient Transport Service Transport for patients to and from hospital appointments e.g. renal and oncology Provide resilience for A&E service e.g. during winter pressures

17 Vehicles A&E Ambulances Used for frontline A&E duties Rapid Response Cars Frontline paramedic response duties Special Operations response Paramedic Motorbikes Paramedic response units in built up Urban areas Patient Transport Ambulance

Special Operations response Paramedic Motorbikes Paramedic

18 Front Line A&E Ambulance Ford Transit 200PS Chassis Coach Built body Utilised for all Front Line A&E duties This year purchasing van conversions

19 Rapid Response Car Honda 4x4 Converted by In-house workshop op Utilised for;- Front Line Paramedic Response Car duties Special Operations Response Car duties Patient Transport duties (Unmarked)

20 Paramedic Motorbike BMW 1200 RTP Utilised for Paramedic Response in built up Urban areas

21 SORT Landrover

22 SORT Polaris

23 Island A&E Ambulance Volkswagen Transporter 44V 4x4 Van Ambulance Conversion Utilised for A&E duties on small remote Islands Consideration being given to utilisation in Rural locations on Mainland

24 Patient t Transport Ambulance Renault Master Van Various Conversions;- All Seated 8 seats Stretcher + 5 seats 2 Stretcher + 3 seats Stretcher + 7 Seats Utilised for all Patient Transport Operations

25 Strategic Direction Focused on 5 key areas: Unscheduled Care Scheduled Care Remote and Rural ehealth Doing the right thing Key to all of the above is partnership p working

26 Unscheduled Care Common triage tool Streaming gpatients from two telephone numbers down appropriate care pathways Hear and refer Hear and treat See and refer See and treat

27 Common Triage Tool

28 Scheduled Care Patient Transport Services Deliver a clinically focussed service Medical/Clinical Eligibility Criteria for patients Focus on streamlining systems and processes Central call handling and planning Better use of technology, for example Implementation of an appropriate PTS Mobile Data Solution, providing Automatic ti Vehicle Location, Satellite Navigation, Electronic Patient Log Sheets and Patient Report Forms Improve information sharing, training & education across all stakeholders

29 Remote and Rural Community Resilience Community engagement Retained Ambulance personnel Community First Responders

30 Retained Ambulance Service Although remote, the public still have access to appropriate level of care for their need equity of service provision SAS employ local people to deliver an accredited service, trained by the Service Backed up by experienced crews First retained scheme - Lerwick

31 Community First Responders What is a Community First Responder Usually (but not exclusively) a lay person, trained in basic life support and the use of a defibrillator, who makes themselves available to be sent by Ambulance control to attend a potentially life-threatening emergency First Responder Groups 1,200 Community First Responders

32 ehealth Common triage tool Electronic Patient Report Form (e PRF) PTS Mobile Data ECG telemetry Tele medicine

33 National Quality Criteria Health, Equality, Access & Treatment - HEAT quality measures Three key aims: To improve patient access and referral to the most appropriate care To deliver the best service for patients To engage with all our partners and communities to deliver improved healthcare

34 Health quality measures SAS H1: Between 12-20% of eligible cardiac arrest patients with Return of Spontaneous Circulation (ROSC) on arrival at hospital. SAS H2: Reach 80% of cardiac arrest patients within 8 minutes (mainland). SAS H3: Reach 75% of Category A (life-threatening) t i emergency incidents within 8 minutes (mainland) SAS H4: Reach 95% of Category B (serious but not life-threatening) incidents within 14 / 19 / 21 minutes (depending on population density) (mainland) SAS H5: Reach 53% of all emergency incidents within 8 minutes (Island NHS Board areas)

35 Efficiency SAS E1: Achieve sickness absence rate of <5% for full year, continuing progress towards the national HEAT standard of 4% SAS E2: Reduce energy consumption by 2.5% per annum SAS E3: Achieve 85% use of Community Health Index (CHI) number for of PTS journeys NHSS E5: NHS Boards to operate within their agreed revenue resource limit; operate within their capital resource limit; meet their cash requirement NHSS E6: NHS Boards to meet their cash efficiency target

36 Access SAS A1: Reach 91% of A&E 1-hour urgent calls within target time SAS A2: Ensure 72% of Priority 1 PTS Patients arrive at hospital 30 minutes or less before appointment time SAS A3: Ensure 90% of Priority 1 PTS Patients are picked up within 30 minutes of agreed time after appointment SAS A4: Ensure that no more than 1 0% of booked PTS SAS A4: Ensure that no more than 1.0% of booked PTS journeys are cancelled by SAS

37 Treatment SAS T2: Compliance with nationally set standards for Healthcare Acquired Infection (HAI) SAS S T3: Treat 12% of emergency e calls at scenee SAS T4: Convey 95-98% of patients with Scottish Early Warning System (SEWS) score above 4 to hospital SAS T5: Convey 80% of hyper acute stroke patients to SAS T5: Convey 80% of hyper acute stroke patients to hospital within 60 minutes of symptom onset

38 Developmental D1: Air Ambulance - Cover all of Scotland within specified time frame from take off in 95 % of cases D2: Inter Hospital Transfers possible developmental measures to include: Response time targets against agreed request times, levels of patient satisfaction with service, appropriateness and effectiveness of use and clinical decision-making; D3: Call Pick Up Times Average call pick up time plus 90% of calls within 10 seconds D4: Trauma Patients development measures to include: Conveying 85% of patients with an Revised Trauma Score of less than 6 to hospital alive.

39 Developmental D5: Hospital Turnaround Times average turnaround times at major hospitals and nationally of 15 minutes. D6: CHI Registrations CHI number recorded on 95% of incidents transferred from NHS24 D7: Acute Asthma Ensure the administration of bronchio-dilators plus or minus Oxygen utilised in 95% of eligible cases D8: Unconscious Patients Possible measure around appropriate airway management undertaken and recorded in 90% of eligible cases

40 Conclusion Norway and Scotland have many similarities in terms of the geography and the remote and rural environments the ambulance services have to work in Scottish Ambulance Service would welcome colleagues from Norway to visit the service and to share best practice

41 TAKK Takk for invitasjonen Jeg har sett frem til å besøke Oslo og Norge og gleder meg nå til fortsettelsen Spørsmål? net

SCOTTISH AMBULANCE SERVICE 2012-13 HEAT DELIVERY PLAN

SCOTTISH AMBULANCE SERVICE 2012-13 HEAT DELIVERY PLAN Scottish Ambulance Service National Headquarters Gyle Square 1 South Gyle Crescent Edinburgh EH12 9EB 16 th March 2011 List of Contents Introduction